1. Sustainable Development and NCDs George Alleyne April 18, 2012 Pan American Health Organization

2. Presentation Concept of sustainable development Sustainable Human Development (SHD) What makes it sustainable? The place of health SHD and NCDs NCDs in LAC NCDs in Rio+ 20 Conclusions

3. Rachel Carson 1907-1964 Only within the moment of time represented by the present century has one species -- man -- acquired significant power to alter the nature of his world ( The Silent Spring, 1962 )

4. Gro Harlem Brundtland “ Our Common Future” The World Commission on Environment and Development (1987 ) Sustainable development: “ Development that meets the needs of the present without compromising the ability of future generations to meet their own needs”

5. Sustainable development Our Common Future “ The concept of sustainable development does imply limits –not absolute limits, but limitations imposed on environmental resources and by the ability of the biosphere to absorb the effects of human activities”

6. Rio-UNCED 1992 The spirit of the conference was captured by the expression "Harmony with Nature", brought into the fore with the first principle of the Rio Declaration: "Human beings are at the centre of concerns for sustainable development. They are entitled to a healthy and productive life in harmony with nature".“ The spirit of the conference was captured by the expression "Harmony with Nature", brought into the fore with the first principle of the Rio Declaration: "Human beings are at the centre of concerns for sustainable development. They are entitled to a healthy and productive life in harmony with nature".“

7. The Johannesburg Declaration created “a collective responsibility to advance and strengthen the interdependent and mutually reinforcing pillars of sustainable development—economic development, social development and environmental protection—at local, national, regional and global levels.” The Johannesburg Declaration created “a collective responsibility to advance and strengthen the interdependent and mutually reinforcing pillars of sustainable development—economic development, social development and environmental protection—at local, national, regional and global levels.” Johannesburg 2002

8. Of what? Of whom?

9. Answer to the unanswered question Development of what? Development of whom? “Development has a face, and that face is the face of man” Dr. Eric Williams (1973) PM Trinidad and Tobago The anthropocentric view

10. Other graphical representations

11. Human development Social Economic Environment

12. Current basic concepts Sustainable development is NOT only about the environment- preservation of natural resources The definition characterizes sustainability and NOT development We must characterize development as Human Development

13. “Human development is a process of enlarging people’s choices. The most critical ones.” are to lead a long and healthy life, to be educated and to enjoy a decent standard of living.” Mahbub Ul Haq

14. Development can be seen, it is argued here, as a process of expanding the real freedoms that people enjoy

15. Capabilities-what are persons able to be and do-their substantial freedoms

16. The most important things in life. (% responses) MaleFemaleTotal Good health424044 Happy family life364038 Employment3027 Live in a country without war 141917 Source: Millennium Gallup Poll 1999

17. Health is an end of Human Development Health is an instrument of Human Development Health is one component of the social strand ( health, education, political freedom etc) NCDs can make human development unsustainable through negative impact on health as well as on the three strands of the helix Therefore: the control and prevention of NCDs must figure in any goal for sustainable human development

18. NCDs on sustainability strands Social Economic Environment NCDs Note also the reverse causality

19. Impact on social strand Equity Equity unfair distribution of life chances-inequity unfair distribution of life chances-inequity disproportionate impact on the poor disproportionate impact on the poor Social cohesion Social cohesion stigma and discrimination-esp. cancer and diabetes stigma and discrimination-esp. cancer and diabetes chronic care –social fraction chronic care –social fraction Gender Gender early male death-widowhood and poverty early male death-widowhood and poverty Education

20. Impact on economic strand Effect on macroeconomy Effect on macroeconomy eg 37 $trillion dollars over next 2 decades( Bloom) impact on GDP eg 37 $trillion dollars over next 2 decades( Bloom) impact on GDP Effect on microeconomy Effect on microeconomy poverty and preventing escape from poverty trap poverty and preventing escape from poverty trap Fiscal consequences Fiscal consequences Increased government expenditure in care, pensions etc; reduced government revenue Increased government expenditure in care, pensions etc; reduced government revenue

21. Impact on environmental strand Difficult ? Impossible to show any direct impact of NCDs on the environment. Difficult ? Impossible to show any direct impact of NCDs on the environment. However, it is possible to show impact of the NCD risk factors on the environment e.g However, it is possible to show impact of the NCD risk factors on the environment e.g -Tobacco production and climate change -Tobacco production and climate change -Food production and climate change. -Food production and climate change. (livestock production responsible for 18% (livestock production responsible for 18% global GHG-more than transportation ) global GHG-more than transportation )

22. NCDs in the Americas Total NCD Deaths 2009: 4.5 Million Source PAHO

23. In most countries of LAC Almost half of those with diabetes and one third of those with hypertension are undiagnosed More than half of those with diagnosed diabetes and one fourth of those with diagnosed hypertension are uncontrolled Almost one third of those with diagnosed diabetes and half of those with diagnosed hypertension do not take appropriate medication Source: PAHO, population based surveys of NCD and risk factors

24. Strategies to address NCDs Population based interventions; Primary prevention Clinical interventions Secondary prevention Healthy NCD Society/environment Individual

25. United Nations A/66/L.1 General Assembly Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases September 19-20, 2011 82 Countries 35 Heads of State Civil Society +++ Private Sector UN Agencies

26. The Political Declaration Commitments: Reduce risk factors Strengthen policies and health systems International cooperation Partnerships Research and development Monitoring and evaluation Follow-up

27. Earth Summit 2012 Earth Summit 2012 Objectives Themes

28. “Wish list” for Rio+ 20 Acknowledge NCDs as an “emerging challenge” Acknowledge NCDs as an “emerging challenge” Recognize the outcome of the New York UN HLM as one component for the objectives of Rio + 20 Recognize the outcome of the New York UN HLM as one component for the objectives of Rio + 20 Incorporation into the Declaration the essentials of the commitments made in the UNHLM for NCDs Incorporation into the Declaration the essentials of the commitments made in the UNHLM for NCDs

29. Conclusions Our concern is sustainable human development Our concern is sustainable human development Health is an end as well as a means towards SHD Health is an end as well as a means towards SHD Human development is made sustainable by a helix of three strands-social, economic, environmental Human development is made sustainable by a helix of three strands-social, economic, environmental NCDS impact adversely directly or indirectly on the three strands making HD unsustainable. NCDS impact adversely directly or indirectly on the three strands making HD unsustainable. Thus the case for NCDs prevention and control figuring in sustainable human development Thus the case for NCDs prevention and control figuring in sustainable human development